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Park, Cho, Hwang, and Lee: Evaluation of the Kinetic Chain in Little League Elbow
Clinical Article

Korean J Sports Med 2014;32(2):112-119.

Published online: 17 January 2014

DOI: https://doi.org/10.5763/kjsm.2014.32.2.112

Evaluation of the Kinetic Chain in Little League Elbow

Ki Bong Park, Hyung Lae Cho, Tae Hyok Hwang, Dong Hyun Lee

Department of Orthopaedic Surgery, Good Samsun Hospital, Busan, Korea

Correspondence: Tae Hyok Hwang Department of Orthopaedic Surgery, Good Samsun Hospital, 326 Gaya-daero, Sasang-gu, Busan 617-718, Korea Tel: +82-51-310-9289, Fax: +82-51-310-9348 E-mail: spinehth@gmail.com

Received 23 September 2014       Revised 10 November 2014       Accepted 13 November 2014

Copyright © 2014 The Korean Society of Sports Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This study is to evaluate the abnormalities in the kinetic chain in the players with little league elbow during the medical screening of middle school baseball teams. Ninety-three players were examined with elbow ultrasonography in the field. Using kinetic chain evaluation test, 27 players sonogrphically diagnosed of little league elbow in dominant arm were compared with 25 players who were normal as control. Scapular-spine distance, horizontal flexion test, combined abduction test, and glenohumeral internal rotation deficit were used for evaluating kinetic chain in the upper extremities, while tightness of quadriceps and hamstring muscles, internal rotation of stance leg, and external rotation of stride leg were used for lower extremities. Also, the single leg stance test and finger-floor distance were used for core stability and flexibility. Twenty-five of 27 players (93%) having little league elbow showed kinetic chain abnormalities of either upper or lower extremities or trunk. This rate was significantly higher for the players having the little leaguer's elbow than control (28%) (p=0.017). Each specific tests for evaluating kinetic chain were also more prevalent in little league elbow group than control, and the abnormalities in the upper extremity were more common than those in lower extremity (p=0.026). Combined abduction test (23/27) and limitation of internal rotation of stance leg (16/27) were the most prevalent abnormalities in upper and lower extremity test, respectively. Our findings showed that there are many abnormalities in kinetic chain in players having the little league elbow and it may be associated with pathogenesis of little league elbow.

Keywords: Athletic injury, Little league elbow, Ultrasonography, Kinetic chain

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Fig. 1.
Photograps of scanning technique and corresponding sonographic abnormalities. (A) Transducer is placed on medial aspect of elbow and (B) medial epicondylar apophyseal separation shows more than 1 mm gap (asterisk) between medial epicondyle and trochlea. (C) Medial epicondylar apophyseal fragmentation has bony ossicle distal to medial epicondylar apophysis (arrow). U: ulna, T: trochlea, ME: medial epicondyle.
kjsm-32-112f1.tif
Fig. 2.
Kinetic chain abnormalities of upper extremity. (A) Scapular malposition of right shoulder ch-aracterized by depression of scapula and increased spine-scap-ular distance (arrow lines). Limited mobility of right shoulder in (B) horizontal flexion test and (C) combined abduction test and (D) glenohumeral internal rotation.
kjsm-32-112f2.tif
Fig. 3.
Kinetic chain abnormalities of trunk and core stability. (A) Increased finger-floor distance means trunk inflexibility and core instability shows (B) increased pelvic tilting, hip adduction and knee valgus in stance leg compared with (C) stride leg in single leg stance test.
kjsm-32-112f3.tif
Fig. 4.
Kinetic chain abnormalities of lower extremity. (A) Increased heel buttock distance indicates quadriceps tightness and (B) limited straight leg raising means tightness of hamstring muscles. Rotational hip motion test reveals decreased (C) internal rotation of stance leg and (D) external rotation of stride leg.
kjsm-32-112f4.tif
Table 1.
Demographic characteristics of participants
Characteristic Group A Group B p-value
Age (y) 14.3 (1.2) 14.7 (1.5) 0.454
Height (cm) 170.2 (4.9) 168.1 (4.8) 0.474
Weight (kg) 64.9 (3.5) 62.6 (4.5) 0.634
Body mass index (kg/m2) 22.5 (4.3) 22.2 (3.7) 0.587
Training history (y) 3.8 (1.2) 4.2 (2.1) 0.364
Dominant (right:left) 23：4 20：5 0.837
Position (pitcher:fielder) 13：14 11：14 0.454
Pitch count/wk (only for pitcher) 850 (76) 780 (83) 0.135

The values are given as the mean with standard deviation in parentheses.

Table 2.
Incidence of kinetic chain abnormlities between two groups
Value Group A (n=27) Group B (n=25) p-value
No. of players with abnormal kinetic chain 25 (93) 7 (28) 0.017
Upper extremity abnormalities 23 (85) 6 (24) 0.021
Lower extremity abnormalities∗ 15 (56) 5 (20) 0.036
p-value† 0.026 0.534 -

Values are presented as number (%).

∗ Including core stability and flexibility;

† Difference between upper and lower extremity.

Table 3.
Physical findings for the evaluation of dominant upper extremity kinetic chain
Value Group A (n=27) Group B (n=25) p-value
Increased SSD∗ (>1 cm) 7 (26) 3 (12) 0.044
Positive horizontal flexion test 18 (67) 8 (32) 0.025
Positive combined abduction test 23 (85) 10 (40) 0.035
Glenohumeral internal rotation deficit (>20 o) 10 (37) 2 (8) 0.027

Values are presented as number (%).

∗ SSD: scapular spine distance.

Table 4.
Physical findings for the evaluation of core and lower extremity kinetic chain
Value Group A (n=27) Group B (n=25) p-value
Increased finger-floor distance (>0 cm) 8 (30) 4 (16) 0.043
Positive single leg stance test (uni or bilateral) 10 (37) 5 (20) 0.048
Limited straight leg raising (<70 o) 8 (30) 2 (8) 0.024
Increased heel-buttock distance (>5 cm) 11 (41) 3 (12) 0.027
Limited stance hip internal rotation (<30 o) 16 (60) 4 (16) 0.012
Limited stride hip external rotation (<30 o) 9 (33) 3 (12) 0.036

Values are presented as number (%).

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